Supracerebellar-infratentorial approach to pineal tumors.

Utilizing the Krause exposure, we have operated on 21 cases of tumors of the pineal region encountering a wide variety of histology with an overall 30% incidence of benign lesions. There has been no significant morbidity in the post-operative management of these patients and one surgical death in a patient with a highly malignant glioma who developed a delayed hemorrhage into the tumor following the operation. In those tumors of recognized malignancy, post-operative radiotherapy has been utilized. In tumors of the germinoma, variety radiation of the entire neural axis is advocated. Since many of the patients have undergone radiotherapy prior to our exposure of the pineal tumor, we have had an opportunity to witness the effects of radiation on this region. In those cases of benign tumors we have found dense adhesions between the tumor and the brain, making definitive surgical treatment of the tumor more difficult.